Ten-year experience in transplantation of A2 kidneys into B and O recipients.
BACKGROUND
This article summarizes our 10-year multicenter experience with transplantation of 50 blood group A2 and A2B kidneys into B and O patients.


METHODS
Since 1986, we have transplanted kidneys from 46 cadaver donors and 4 living donors who were blood group A2 (47 donors) or A2B (3 donors) into 19 B and 31 O patients. In 1991, we began allocating these kidneys preferentially to B and O recipients who were selected based on a history of low (< or =4) anti-A IgG isoagglutinin titers. Immunosuppression was no different from that used in ABO-compatible grafts.


RESULTS
The 1-month function rate before thus selecting the patients was 68% (19/28), but is now 94% (17/18). Two-year cadaver-donor graft survival with this selection method is 94%, compared with 88% for 640 concurrent and consecutive ABO-compatible transplants (log-rank, 0.15). All four living-related transplants are still functioning, with a mean follow-up of 71 months. Since we began allocating A2 kidneys preferentially to B and O recipients, the percentage of the B patients who received A2 or A2B kidneys has increased from 29% (8/28) to 55% (10/18).


CONCLUSIONS
Transplantation of A2 or A2B kidneys into B and O patients is clinically equivalent to that of ABO-compatible transplantation when recipients are selected by low pretransplant anti-A titer histories. This approach increases access of blood group B recipients to kidneys.
Nelson
P W
PW
Department of Surgery, University of Missouri, Kansas City, USA.
Landreneau
M D
MD
Luger
A M
AM
Pierce
G E
GE
Ross
G
G
Shield
C F
CF
Warady
B A
BA
Aeder
M I
MI
Helling
T S
TS
Hughes
T M
TM
Beck
M L
ML
Harrell
K M
KM
Bryan
C F
CF
D000017:ABO Blood-Group System / Q000235:genetics / Q000276:immunology; D000206:Actuarial Analysis; D001787:Blood Group Incompatibility; D001788:Blood Grouping and Crossmatching; D005260:Female; D006085:Graft Survival; D006648:Histocompatibility; D006801:Humans; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D009926:Organ Preservation; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome
D000017:ABO Blood-Group System